JP5171471B2 - Endoscopic treatment tool - Google Patents

Endoscopic treatment tool Download PDF

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JP5171471B2
JP5171471B2 JP2008206113A JP2008206113A JP5171471B2 JP 5171471 B2 JP5171471 B2 JP 5171471B2 JP 2008206113 A JP2008206113 A JP 2008206113A JP 2008206113 A JP2008206113 A JP 2008206113A JP 5171471 B2 JP5171471 B2 JP 5171471B2
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treatment
coil sheath
operation unit
axis
rotatable
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JP2010042052A (en
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啓太 鈴木
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Olympus Medical Systems Corp
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Olympus Medical Systems Corp
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Priority to PCT/JP2009/003819 priority patent/WO2010016280A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
    • A61B18/1445—Probes having pivoting end effectors, e.g. forceps at the distal end of a shaft, e.g. forceps or scissors at the end of a rigid rod
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/06—Biopsy forceps, e.g. with cup-shaped jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/003—Steerable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595—Cauterization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Otolaryngology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
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Description

本発明は、経内視鏡的に体腔内に挿入して各種手技に使用される内視鏡用処置具に関する。   The present invention relates to an endoscope treatment tool that is inserted into a body cavity through a transendoscope and used for various procedures.

従来、先端の処置部に組織を把持するための鉗子等を備えた内視鏡用処置具が知られている（例えば、特許文献１参照）。このような鉗子等を用いて体腔内組織に対して処置を行う際に、体腔内に突出した鉗子の開閉方向が処置対象の組織の位置に対して適切でない等の理由で鉗子の開閉向きの調節が必要となることがある。   2. Description of the Related Art Conventionally, an endoscope treatment tool including a forceps or the like for grasping tissue at a distal treatment portion is known (see, for example, Patent Document 1). When performing a treatment on a body cavity tissue using such forceps, the forceps opening / closing direction of the forceps protruding into the body cavity is not appropriate for the position of the tissue to be treated. Adjustment may be required.

特許文献１に記載の内視鏡用処置具では、一対の鉗子片を開閉操作するための操作軸部材はスライダに接続されている。また鉗子片は操作軸部材が挿通された挿入管に、軸線回りの相対回転が不能となるように固定されており、挿入管の基端は操作部に固定されている。
したがって、鉗子の開閉向きを調節する場合、ユーザは操作部全体を軸線回りに回転させる。すると、挿入管が軸線回りに回転し、最終的に鉗子片が軸線回りに回転して開閉向きが調節される。
特許第４０５６９８９号公報 In the endoscope treatment tool described in Patent Document 1, an operation shaft member for opening and closing a pair of forceps pieces is connected to a slider. The forceps piece is fixed to the insertion tube through which the operation shaft member is inserted so that relative rotation about the axis is impossible, and the proximal end of the insertion tube is fixed to the operation portion.
Therefore, when adjusting the opening / closing direction of the forceps, the user rotates the entire operation unit around the axis. Then, the insertion tube rotates around the axis, and finally the forceps piece rotates around the axis to adjust the opening / closing direction.
Japanese Patent No. 4056899

しかしながら、特許文献１に記載の内視鏡用処置具では、操作部全体を回転させなければ鉗子の開閉向きを調節することができず、所定の回転角度以上鉗子片を回転させたい等の場合、操作部の持ち替えが必要となるため、操作が煩雑になるという問題がある。   However, in the endoscope treatment tool described in Patent Document 1, the opening / closing direction of the forceps cannot be adjusted unless the entire operation unit is rotated, and the forceps piece is rotated more than a predetermined rotation angle. Since the operation part needs to be changed, there is a problem that the operation becomes complicated.

また、コイル等で形成される挿入管は、操作部の回転によって発生するトルクを好適に先端の鉗子片に伝達するが、細径の操作軸部材は当該トルクの伝達率が挿入管に比して低いため、両者の伝達率の差により回転ひずみが発生して操作軸部材に蓄積される。これによって、鉗子片が操作部の回転に良好に追随せず、ある程度操作部が回転されたところで操作軸部材に蓄積された回転ひずみが一気に開放されて鉗子片が一度に大きな角度量回転する、いわゆる回転とびが発生する。したがって、鉗子片の開閉向きの微細な調節が困難となるという問題も存在する。   In addition, the insertion tube formed of a coil or the like preferably transmits the torque generated by the rotation of the operation portion to the forceps piece at the tip, but the operation shaft member with a small diameter has a transmission rate of the torque compared to the insertion tube. Therefore, rotational distortion occurs due to the difference between the transmission rates of the two, and is accumulated in the operation shaft member. Thereby, the forceps piece does not follow the rotation of the operation part well, and when the operation part is rotated to some extent, the rotational strain accumulated in the operation shaft member is released at once, and the forceps piece is rotated by a large angle amount at a time. A so-called rotation jump occurs. Therefore, there is a problem that it is difficult to finely adjust the opening and closing direction of the forceps piece.

本発明は上記事情に鑑みて成されたものであり、処置部の回転とび等を発生させずに、容易な操作で処置部の向き調節を適切に行うことができる内視鏡用処置具を提供することを目的とする。   The present invention has been made in view of the above circumstances, and provides an endoscopic treatment tool that can appropriately adjust the orientation of a treatment section with an easy operation without causing a rotation skip or the like of the treatment section. The purpose is to provide.

本発明の内視鏡用処置具は、体腔内組織に対して処置を行うための処置部と、前記処置部の基端に接続された操作ワイヤと、前記操作ワイヤが挿通された可撓性を有するコイルシースと、前記コイルシースが挿通された絶縁性の被覆管と、前記処置部を操作するための操作部とを備え、前記操作部は、前記操作ワイヤの基端が軸線回りに回転自在に接続された進退操作部と、前記進退操作部が軸線方向に進退可能に取り付けられた本体と、前記本体に対して軸線回りに回転可能に取り付けられ、前記コイルシースの基端が軸線回りに回転不能に取り付けられた回転操作部とを有し、前記被覆管の先端は、前記コイルシースの先端に軸線回りに回転可能かつ軸線方向に進退不能に取り付けられており、前記被覆管の基端側は、前記コイルシースに対して軸線方向に相対移動可能となるように離間しており、かつ前記コイルシースが湾曲しても前記コイルシースが露出しないように、所定の長さ以上前記操作部によって被覆されていることを特徴とする。
An endoscope treatment tool according to the present invention includes a treatment portion for performing treatment on tissue in a body cavity, an operation wire connected to a proximal end of the treatment portion, and a flexibility through which the operation wire is inserted. A coil sheath having a coil sheath, an insulating sheath tube through which the coil sheath is inserted, and an operation portion for operating the treatment portion. The operation portion is configured such that a proximal end of the operation wire is rotatable about an axis. A connected advance / retreat operation unit, a main body on which the advance / retreat operation unit is attached so as to be able to advance and retreat in the axial direction, and a main body attached to the main body so as to be rotatable about the axis, and the proximal end of the coil sheath cannot be rotated about the axis The distal end of the cladding tube is attached to the distal end of the coil sheath so as to be rotatable about an axis and not to be movable back and forth in the axial direction. Coil sheath It is spaced apart so as to be relatively movable in the axial direction, and is covered by the operation portion for a predetermined length or more so that the coil sheath is not exposed even if the coil sheath is curved. To do.

本発明の内視鏡用処置具によれば、回転操作部を回転させることによって本体を回転させずに処置部を回転させることができる。そして、回転操作によって操作ワイヤに蓄積される回転ひずみは、操作ワイヤの基端が軸線回りに回転自在に進退操作部に接続され、かつ被覆管の基端側がコイルシースに対して軸線方向に相対移動可能となるように離間していることにより、随時好適に開放される。   According to the endoscope treatment tool of the present invention, the treatment section can be rotated without rotating the main body by rotating the rotation operation section. The rotational strain accumulated in the operation wire by the rotation operation is such that the proximal end of the operation wire is connected to the advancing / retreating operation part so as to be rotatable about the axis, and the proximal end side of the cladding tube is moved relative to the coil sheath in the axial direction. By being separated so as to be possible, it is suitably opened as needed.

前記操作ワイヤの前記基端は、導電体からなるボールベアリングを用いて、前記進退操作部に対して軸線回りに回転自在に接続されており、前記進退操作部は、電源と接続されるためのプラグを有し、前記プラグは、前記ボールベアリングを介して前記操作ワイヤと導通してもよい。
この場合、操作ワイヤに蓄積される回転ひずみを好適に開放させつつ、プラグと操作ワイヤとを確実に導通し、処置部に通電して各種処置を行うことができる。 The proximal end of the operation wire is connected to the advance / retreat operation unit so as to be rotatable about an axis using a ball bearing made of a conductor, and the advance / retreat operation unit is connected to a power source. A plug may be provided, and the plug may be electrically connected to the operation wire via the ball bearing.
In this case, the plug and the operation wire can be reliably conducted while the rotational strain accumulated in the operation wire is suitably released, and various treatments can be performed by energizing the treatment section.

本発明の内視鏡用処置具によれば、処置部の回転とび等を発生させずに、容易な操作で処置部の向き調節を適切に行うことができる。   According to the endoscope treatment tool of the present invention, it is possible to appropriately adjust the orientation of the treatment section with an easy operation without causing rotation and the like of the treatment section.

以下、図１から図４を参照して本発明の第１実施形態の内視鏡用処置具について説明する。図１に示すように、本実施形態の内視鏡用処置具（以下、単に「処置具」と称する。）１は、体腔内組織に対して処置を行うための処置部２と、処置部２の基端に接続された操作ワイヤ３と、操作ワイヤ３と接続された、処置部２を操作するための操作部４と、処置部２と操作部４とを接続するための挿入部５とを備えて構成されている。   Hereinafter, the endoscope treatment tool according to the first embodiment of the present invention will be described with reference to FIGS. 1 to 4. As shown in FIG. 1, an endoscope treatment tool (hereinafter simply referred to as “treatment tool”) 1 according to the present embodiment includes a treatment section 2 for performing a treatment on tissue in a body cavity, and a treatment section. 2, an operation wire 3 connected to the proximal end, an operation unit 4 connected to the operation wire 3 for operating the treatment unit 2, and an insertion unit 5 for connecting the treatment unit 2 and the operation unit 4. And is configured.

図２は処置部２を含む処置具１の先端部分の拡大断面図である。処置部２は、第１鉗子部材６と第２鉗子部材７との一対の鉗子部材が、回動軸８で互いに回動自在に連結されて構成されている。各鉗子部材６、７の回動軸８よりも基端側には、操作ワイヤ３が接続されており、挿入部５内を通って操作部４に接続されている。   FIG. 2 is an enlarged cross-sectional view of the distal end portion of the treatment instrument 1 including the treatment portion 2. The treatment section 2 is configured by a pair of forceps members including a first forceps member 6 and a second forceps member 7 connected to each other by a rotation shaft 8 so as to be rotatable. An operation wire 3 is connected to the proximal end side of each forceps member 6, 7 with respect to the rotation shaft 8, and is connected to the operation unit 4 through the insertion unit 5.

挿入部５は、コイルシース９と、コイルシース９の外周を覆う絶縁チューブ（被覆管）１０とを備えている。
コイルシース９は、金属の素線をループ状に密に巻いて形成されており、後述する処置部２を回転するための操作を良好に処置部２まで伝える。コイルシース９の構成について、一本の金属素線を巻く単条か複数本の金属素線を巻く多条型とするか、及び径方向に巻き重ねない単層型か複数回巻き重ねる多層型とするか等は、処置具１の用途等に鑑みてコイルシース９に要求される特性によって適宜決定されてよい。 The insertion portion 5 includes a coil sheath 9 and an insulating tube (cladding tube) 10 that covers the outer periphery of the coil sheath 9.
The coil sheath 9 is formed by densely winding a metal wire in a loop shape, and successfully transmits an operation for rotating the treatment unit 2 described later to the treatment unit 2. Regarding the configuration of the coil sheath 9, a single strip wound with one metal strand or a multiple strip shape wound with a plurality of metal strands, and a single layer type that is not wound in the radial direction or a multilayer type that is wound a plurality of times Whether or not to do so may be determined as appropriate according to the characteristics required of the coil sheath 9 in view of the application of the treatment instrument 1 or the like.

コイルシース９の先端には、処置部２を固定するためのカバー１１が取り付けられており、カバー１１によって回動軸８とコイルシース９とが一体に接続されている。これによって、回動軸８は、コイルシース９の軸線方向に相対移動不能となっている。   A cover 11 for fixing the treatment section 2 is attached to the tip of the coil sheath 9, and the rotating shaft 8 and the coil sheath 9 are integrally connected by the cover 11. Thereby, the rotation shaft 8 is not relatively movable in the axial direction of the coil sheath 9.

絶縁チューブ１０は、絶縁性の材料で形成され、コイルシース９の外面を被覆して絶縁性を確保している。絶縁チューブ１０の先端には、略円筒状の係合部材１２が圧入等によって取り付けられている。係合部材１２は、コイルシース９の先端付近に周方向にわたって形成された係合溝９Ａと係合している。
このような構成をとることで、絶縁チューブ１０の先端は、コイルシース９に対して、軸線回りに回転自在かつ軸線方向に相対移動不能に取り付けられている。 The insulating tube 10 is made of an insulating material and covers the outer surface of the coil sheath 9 to ensure insulation. A substantially cylindrical engaging member 12 is attached to the distal end of the insulating tube 10 by press fitting or the like. The engaging member 12 is engaged with an engaging groove 9 </ b> A formed in the vicinity of the distal end of the coil sheath 9 in the circumferential direction.
By adopting such a configuration, the distal end of the insulating tube 10 is attached to the coil sheath 9 so as to be rotatable around the axis and not relatively movable in the axial direction.

図３は、操作部４の拡大断面図である。操作部４は、細長の本体１３と、本体１３に対して軸線まわりに回転自在に取り付けられた回転操作部１４と、本体１３に対して軸線方向に一定範囲摺動可能に取り付けられたスライダ（進退操作部）１５とを備えて構成されている。   FIG. 3 is an enlarged cross-sectional view of the operation unit 4. The operation unit 4 includes an elongated main body 13, a rotary operation unit 14 attached to the main body 13 so as to be rotatable around an axis, and a slider (slidably attached to the main body 13 in a certain range in the axial direction). (Advance / retreat operation unit) 15.

本体１３は、内部に操作ワイヤ３や挿入部５の基端側の領域を収容可能な溝やスリット等の空間を有する。本体１３の基端には、指掛用のハンドル１６が設けられている。   The main body 13 has a space such as a groove or a slit that can accommodate a region on the proximal end side of the operation wire 3 or the insertion portion 5 therein. A finger handle 16 is provided at the base end of the main body 13.

回転操作部１４は、挿入部５の基端側が挿通される管状部材１７と、管状部材１７に取り付けられたダイヤル部材１８とからなる。
管状部材１７には、軸線方向に延びる貫通孔１７Ａが形成されており、挿入部５の基端側の領域が貫通孔１７Ａに挿入されている。そして、コイルシース９の基端は管状部材１７の基端側に、管状部材１７に対して軸線回りに回転不能に接続固定されている。 The rotation operation unit 14 includes a tubular member 17 through which the proximal end side of the insertion unit 5 is inserted, and a dial member 18 attached to the tubular member 17.
A through hole 17A extending in the axial direction is formed in the tubular member 17, and a region on the proximal end side of the insertion portion 5 is inserted into the through hole 17A. The proximal end of the coil sheath 9 is connected and fixed to the proximal end side of the tubular member 17 so as not to rotate about the axis with respect to the tubular member 17.

一方、絶縁チューブ１０は基端側が所定の長さ、例えば３０ミリメートル程度貫通孔１７Ａに挿入されており、操作部４によって被覆されている。そして、絶縁チューブ１０の基端１０Ａはコイルシース９の基端よりも先端側に位置し、なおかつ管状部材１７及びコイルシース９のいずれにも固定されずに離間した状態とされている。これによって、基端１０Ａは、コイルシース９に対して軸線方向に移動可能となっている。なお、処置具１の使用時における基端１０Ａの挙動については後述する。   On the other hand, the base side of the insulating tube 10 is inserted into the through hole 17A of a predetermined length, for example, about 30 millimeters, and is covered with the operation unit 4. The base end 10 </ b> A of the insulating tube 10 is positioned on the distal end side with respect to the base end of the coil sheath 9, and is not fixed to any of the tubular member 17 and the coil sheath 9 and is separated. Thereby, the base end 10 </ b> A is movable in the axial direction with respect to the coil sheath 9. Note that the behavior of the proximal end 10A when the treatment tool 1 is used will be described later.

ダイヤル部材１８は、管状部材１７に対して略同軸となるように取り付けられているが、管状部材１７とダイヤル部材１８との接続部位１７Ｂにおいて、管状部材１７の軸線方向に直行する断面が略正方形に形成されているため、両者は相対回転不能となっている。したがって、ダイヤル部材１８を軸線回りに回転操作すると、管状部材１７も連動して軸線回りに回転し、その結果回転操作部１４全体が軸線回りに回転される。   The dial member 18 is attached so as to be substantially coaxial with the tubular member 17, but the cross section perpendicular to the axial direction of the tubular member 17 is substantially square at the connection portion 17 </ b> B between the tubular member 17 and the dial member 18. Therefore, the two cannot be rotated relative to each other. Therefore, when the dial member 18 is rotated around the axis, the tubular member 17 is also rotated around the axis, and as a result, the entire rotation operation unit 14 is rotated around the axis.

スライダ１５には、図示しない高周波電源と接続された図示しない電源ケーブルが接続されるためのプラグ１９が取り付けられている。本体１３の内部に位置するプラグ１９の端部には、プラグ１９の軸線方向に延びる回転溝１９Ａが形成されている。
回転溝１９Ａには、略円盤状の回転プレート２０が配置されている。回転プレート２０には、操作ワイヤ３の座屈を防ぐためのパイプ２１が、回転プレート２０と同軸となるように固定されている。管状部材１７の基端を通って延びてきた操作ワイヤ３の基端は、パイプ２１に挿入されて、ロウ付け等によりパイプ２１に一体に固定されている。
これらの構成により、操作ワイヤ３の基端は、パイプ２１及び回転プレート２０を介して、スライダ１５に対して軸線回りに回転可能に接続されている。 A plug 19 for connecting a power cable (not shown) connected to a high-frequency power source (not shown) is attached to the slider 15. A rotation groove 19 </ b> A extending in the axial direction of the plug 19 is formed at the end of the plug 19 located inside the main body 13.
A substantially disk-shaped rotating plate 20 is disposed in the rotating groove 19A. A pipe 21 for preventing buckling of the operation wire 3 is fixed to the rotary plate 20 so as to be coaxial with the rotary plate 20. The proximal end of the operation wire 3 extending through the proximal end of the tubular member 17 is inserted into the pipe 21 and is integrally fixed to the pipe 21 by brazing or the like.
With these configurations, the proximal end of the operation wire 3 is connected to the slider 15 via the pipe 21 and the rotating plate 20 so as to be rotatable about the axis.

上記のように構成された処置具１の使用時の動作について説明する。
まずユーザは、患者の体内に図示しない内視鏡を挿入し、処置対象の体腔内組織付近まで当該内視鏡の先端を進める。 An operation at the time of use of the treatment instrument 1 configured as described above will be described.
First, the user inserts an endoscope (not shown) into the patient's body and advances the distal end of the endoscope to the vicinity of the tissue in the body cavity to be treated.

続いて、ユーザはスライダ１５を本体１３に対して後退させて処置部２を閉じた状態とし、内視鏡の図示しない鉗子チャンネルに処置具１の処置部２及び挿入部５を挿入する。そして、処置部２を鉗子チャンネルから突出させた後、高周波電源とプラグ１９とを電源ケーブルで接続する。   Subsequently, the user retracts the slider 15 with respect to the main body 13 to close the treatment section 2 and inserts the treatment section 2 and the insertion section 5 of the treatment instrument 1 into a forceps channel (not shown) of the endoscope. And after making the treatment part 2 protrude from a forceps channel, a high frequency power supply and the plug 19 are connected with a power cable.

処置を行う際には、スライダ１５を本体１３に対して前進移動させる。すると、スライダ１５に接続された操作ワイヤ３がコイルシース９に対して前進する。上述のように、回動軸８は挿入部５に対して相対移動不能であるので、第１鉗子部材６及び第２鉗子部材７は、それぞれ回動軸８を中心に回動して、処置部２が開く。   When performing the treatment, the slider 15 is moved forward relative to the main body 13. Then, the operation wire 3 connected to the slider 15 moves forward with respect to the coil sheath 9. As described above, since the rotation shaft 8 cannot move relative to the insertion portion 5, the first forceps member 6 and the second forceps member 7 rotate about the rotation shaft 8, respectively. Part 2 opens.

ユーザが対象組織を処置部２の開いた鉗子部材６、７間に位置させて、スライダ１５を本体１３の基端側に引き戻すと、鉗子部材６、７の先端側が再び閉じられ、処置部２に対象組織が挟み込まれる。   When the user places the target tissue between the open forceps members 6 and 7 of the treatment section 2 and pulls the slider 15 back to the proximal end side of the main body 13, the distal ends of the forceps members 6 and 7 are closed again, and the treatment section 2. The target tissue is sandwiched between the two.

この状態で、ユーザが高周波電源から高周波電流を供給すると、高周波電流はプラグ１９から操作ワイヤ３を通って処置部２まで供給され、高周波電流によって対象組織が焼灼される。
処置終了後、ユーザは、高周波処置具１を鉗子チャンネルから抜去し、かつ、内視鏡を体外へ抜去させて手技を終了する。 In this state, when the user supplies a high-frequency current from the high-frequency power source, the high-frequency current is supplied from the plug 19 through the operation wire 3 to the treatment unit 2 and the target tissue is cauterized by the high-frequency current.
After the treatment, the user removes the high-frequency treatment tool 1 from the forceps channel and removes the endoscope from the body to finish the procedure.

以上が処置具１の通常の使用時の動作であるが、鉗子チャンネルから突出した処置部２の鉗子部材６、７の開閉の向きが、処置対象の組織に対して適切でない場合、そのままでは処置部２による処置を好適に行えないことがある。このような場合、ユーザは回転操作部１４を操作して処置部２を軸線回りに回転させる調節操作を行う。以下、この調節操作時における処置具１の各部の動作について説明する。   The above is the operation during normal use of the treatment instrument 1. However, if the opening / closing direction of the forceps members 6 and 7 of the treatment portion 2 protruding from the forceps channel is not appropriate for the tissue to be treated, the treatment is performed as it is. The treatment by the part 2 may not be suitably performed. In such a case, the user operates the rotation operation unit 14 to perform an adjustment operation for rotating the treatment unit 2 around the axis. Hereinafter, the operation of each part of the treatment instrument 1 during this adjustment operation will be described.

調節操作を行う場合、ユーザは回転操作部１４のダイヤル部材１８を軸線回りに所望の方向へ回転させる。すると、管状部材１７、及び管状部材１７に相対回転不能に取り付けられたコイルシース９が連動してダイヤル部材１８と同一方向に回転する。
コイルシース９が回転すると、カバー１１によってコイルシース９と一体となった処置部２が回転されて鉗子部材６、７の開閉向きが調節できる。 When performing the adjustment operation, the user rotates the dial member 18 of the rotation operation unit 14 around the axis in a desired direction. Then, the tubular member 17 and the coil sheath 9 attached to the tubular member 17 so as not to rotate relative to each other rotate in the same direction as the dial member 18.
When the coil sheath 9 is rotated, the treatment portion 2 integrated with the coil sheath 9 is rotated by the cover 11 so that the opening / closing direction of the forceps members 6 and 7 can be adjusted.

このとき、処置部２の回転に伴い、処置部２の基端に接続された操作ワイヤ３も回転されるが、操作ワイヤ３のトルク伝達性はコイルシース９に比較して低いので、操作ワイヤ３には回転ひずみが蓄積されやすくなる。
しかし、操作ワイヤ３の基端は、パイプ２１及び回転プレート２０を介してスライダ１５のプラグ１９に対して回転自在に接続されているので、蓄積された回転ひずみは、この基端で随時開放され、回転とびが発生することが防止される。 At this time, the operation wire 3 connected to the proximal end of the treatment unit 2 is also rotated with the rotation of the treatment unit 2, but the torque transmission property of the operation wire 3 is lower than that of the coil sheath 9. Tends to accumulate rotational strain.
However, since the proximal end of the operation wire 3 is rotatably connected to the plug 19 of the slider 15 via the pipe 21 and the rotating plate 20, the accumulated rotational strain is released at any time at this proximal end. Rotation skip is prevented from occurring.

また、回転操作時には処置具１は内視鏡の鉗子チャンネルに挿通されているため、絶縁チューブ１０が鉗子チャンネルの内壁との間に生じる摩擦力によって、実質的に内壁に対して相対回転不能に固定される。しかし、絶縁チューブ１０の先端はコイルシース９に対して相対回転可能に取り付けられているので、上述のように絶縁チューブ１０が鉗子チャンネルに固定されていても、当該固定状態はコイルシース９を介した処置部２の回転操作に影響を与えない。   Further, since the treatment instrument 1 is inserted into the forceps channel of the endoscope during the rotation operation, the insulating tube 10 is substantially unable to rotate relative to the inner wall due to the frictional force generated between the inner wall of the forceps channel. Fixed. However, since the distal end of the insulating tube 10 is attached so as to be rotatable relative to the coil sheath 9, even if the insulating tube 10 is fixed to the forceps channel as described above, the fixed state is a treatment via the coil sheath 9. It does not affect the rotation operation of part 2.

さらに、絶縁チューブの基端１０Ａは、管状部材１７やコイルシース９に対して固定されておらず、離間したフリーの状態となっている。したがって、図４に示すように、内視鏡が体腔内で蛇行する等によってコイルシース９が湾曲したときは、湾曲に伴うコイルシース９の変形に対応して、基端１０Ａが先端側に移動する。基端１０Ａが管状部材１７やコイルシース９に固定されていると、湾曲に伴うコイルシース９の変形によって絶縁チューブ１０が軸線方向に圧縮されたり引き伸ばされたりして可撓性が低下し、回転とび発生の一つの原因となるが、基端１０Ａがフリーの状態になることで、絶縁チューブ１０の圧縮や引き伸ばしが好適に抑制される。   Furthermore, the base end 10A of the insulating tube is not fixed with respect to the tubular member 17 or the coil sheath 9, and is in a separated free state. Therefore, as shown in FIG. 4, when the coil sheath 9 is bent due to the meandering of the endoscope in the body cavity, the proximal end 10 </ b> A moves to the distal end side corresponding to the deformation of the coil sheath 9 accompanying the bending. When the proximal end 10A is fixed to the tubular member 17 or the coil sheath 9, the insulation tube 10 is compressed or stretched in the axial direction due to the deformation of the coil sheath 9 due to the bending, so that the flexibility is lowered and the rotation jump occurs. However, when the base end 10A is in a free state, the insulation tube 10 is preferably suppressed from being compressed or stretched.

本実施形態の処置具１によれば、上述したそれぞれの効果があいまって、操作ワイヤ３に回転ひずみが蓄積されることによる回転とびの発生を抑えつつ、回転操作部１４を操作することによって、所望の回転量だけ確実に処置部２を回転させ、処置部２の向きの調節を好適に行うことができる。   According to the treatment instrument 1 of the present embodiment, by operating the rotary operation unit 14 while suppressing the occurrence of rotational jump due to the combined effects of the above-described effects and accumulation of rotational strain in the operation wire 3, The treatment section 2 can be reliably rotated by a desired amount of rotation, and the orientation of the treatment section 2 can be suitably adjusted.

また、挿入部５の絶縁チューブ１０の基端１０Ａが、所定の長さだけ操作部４の管状部材１７に挿通され、絶縁チューブの１０の基端１０Ａ側の領域が一定範囲操作部４に覆われている。したがって、図４に示すように挿入部５が湾曲して基端１０Ａが先端側に移動しても、コイルシース９の導電性の外面が露出することがなく、絶縁状態をより確実に保持することができる。   Further, the base end 10A of the insulating tube 10 of the insertion portion 5 is inserted through the tubular member 17 of the operation portion 4 by a predetermined length, and the region on the base end 10A side of the insulation tube 10 is covered with the fixed range operation portion 4. It has been broken. Therefore, as shown in FIG. 4, even if the insertion portion 5 is curved and the proximal end 10A moves to the distal end side, the conductive outer surface of the coil sheath 9 is not exposed, and the insulation state is more reliably maintained. Can do.

本実施形態においては、プラグ１９を備えて処置部２が通電される処置具の例を説明したが、本発明は処置部に通電をしない処置具についても適用することが可能である。すなわち、スライダ１５にプラグ１９を設けず、スライダ１５の一部に回転溝１９Ａと同等の形状を形成して回転プレート２０を配置することによって、処置部に通電をしない処置具であっても同様に上述した効果を得ることができる。   In the present embodiment, an example of a treatment instrument provided with the plug 19 and energizing the treatment section 2 has been described, but the present invention can also be applied to a treatment instrument that does not energize the treatment section. That is, even if the treatment tool does not energize the treatment portion by providing the rotary plate 20 by forming a shape equivalent to the rotation groove 19A in a part of the slider 15 without providing the plug 19 on the slider 15. The effects described above can be obtained.

次に、本発明の第２実施形態について、図５を参照して説明する。本実施形態の処置具３１と上述の処置具１との異なるところは、操作ワイヤとスライダとの接続態様である。
なお、第１実施形態の処置具１と共通する構成については、同一の符号を付して、重複する説明を省略する。 Next, a second embodiment of the present invention will be described with reference to FIG. The difference between the treatment tool 31 of the present embodiment and the above-described treatment tool 1 is a connection mode between the operation wire and the slider.
In addition, about the structure which is common in the treatment tool 1 of 1st Embodiment, the same code | symbol is attached | subjected and the overlapping description is abbreviate | omitted.

図５は、処置具３１の操作部３２の部分拡大断面図である。パイプ２１とプラグ１９とは、ボールベアリング３３を介して相対回転可能に接続されている。
ボールベアリング３３としては、公知の構成のものを採用することができるが、ボール（不図示）を含むすべての部材がステンレス等の導電体で形成されると、プラグ１９と操作ワイヤ３とをボールベアリング３３を介して電気的に接続できるため好ましい。
なお、この場合、導通を良好にするために、ボールには潤滑性を高めるためのグリスを塗布しないのが好ましい。通常、処置具２の回転操作に伴うボールベアリング３３の回転量は一般的なボールベアリングに比較して著しく少ないので、ボールベアリング３３を構成する各部材の表面が充分滑らかに加工されていれば、グリスを塗布しなくても問題はない。 FIG. 5 is a partial enlarged cross-sectional view of the operation unit 32 of the treatment instrument 31. The pipe 21 and the plug 19 are connected via a ball bearing 33 so as to be relatively rotatable.
As the ball bearing 33, a known structure can be adopted. However, when all members including a ball (not shown) are formed of a conductor such as stainless steel, the plug 19 and the operation wire 3 are connected to the ball. Since it can electrically connect via the bearing 33, it is preferable.
In this case, it is preferable not to apply grease for improving lubricity to the ball in order to improve conduction. Usually, the rotation amount of the ball bearing 33 accompanying the rotation operation of the treatment instrument 2 is remarkably small as compared with a general ball bearing. Therefore, if the surface of each member constituting the ball bearing 33 is processed sufficiently smoothly, There is no problem even if grease is not applied.

本実施形態の処置具３１においても、上述の処置具１と同様の効果を得ることができる。
また、操作ワイヤ３とスライダ１５のプラグ１９とがボールベアリング３３を介して接続されているので、両者の相対回転がより円滑となり、操作ワイヤ３に蓄積される回転ひずみをより好適に開放させることができる。 Also in the treatment tool 31 of this embodiment, the same effect as the above-mentioned treatment tool 1 can be acquired.
Further, since the operation wire 3 and the plug 19 of the slider 15 are connected via the ball bearing 33, the relative rotation between the two becomes smoother, and the rotational strain accumulated in the operation wire 3 is more preferably released. Can do.

以上、本発明の各実施形態について説明したが、本発明の技術的範囲は上記各実施形態に限定されるものではなく、本発明の趣旨を逸脱しない範囲において種々の変更を加えることが可能である。   While the embodiments of the present invention have been described above, the technical scope of the present invention is not limited to the above embodiments, and various modifications can be made without departing from the spirit of the present invention. is there.

例えば、上述の各実施形態においては、処置部が一対の鉗子部材からなる例を説明したが、本発明の処置具における処置部はこれには限定されない。すなわち、処置対象の組織に対して向きの調節をする必要がある処置部であれば、例えばスネアワイヤやいわゆる二脚鉗子等、あらゆる処置部に適用することができる。   For example, in each of the above-described embodiments, an example in which the treatment portion is formed of a pair of forceps members has been described, but the treatment portion in the treatment tool of the present invention is not limited to this. That is, as long as it is a treatment part which needs to adjust direction with respect to the structure | tissue of treatment object, it can apply to all treatment parts, such as a snare wire and what is called a bipod forceps, for example.

本発明の第１実施形態の内視鏡用処置具の全体図である。1 is an overall view of an endoscope treatment tool according to a first embodiment of the present invention. 同内視鏡用処置具の先端側の拡大断面図である。It is an expanded sectional view of the front end side of the treatment tool for endoscopes. 同内視鏡用処置具の操作部の拡大断面図である。It is an expanded sectional view of the operation part of the treatment tool for endoscopes. 同内視鏡用処置具の使用時の動作を示す図である。It is a figure which shows the operation | movement at the time of use of the treatment tool for endoscopes. 本発明の第２実施形態の内視鏡用処置具の操作部を示す部分拡大断面図である。It is a partial expanded sectional view which shows the operation part of the treatment tool for endoscopes of 2nd Embodiment of this invention.

符号の説明Explanation of symbols

１、３１ 内視鏡用処置具
２ 処置部
３ 操作ワイヤ
４、３２ 操作部
９ コイルシース
１０ 絶縁チューブ（被覆管）
１３ 本体
１４ 回転操作部
１５ スライダ（進退操作部）
３３ ボールベアリング DESCRIPTION OF SYMBOLS 1,31 Endoscope treatment tool 2 Treatment part 3 Operation wire 4, 32 Operation part 9 Coil sheath 10 Insulating tube (clad tube)
13 Main body 14 Rotation operation section 15 Slider (advance / retreat operation section)
33 Ball bearing

Claims (2)

体腔内組織に対して処置を行うための処置部と、
前記処置部の基端に接続された操作ワイヤと、
前記操作ワイヤが挿通された可撓性を有するコイルシースと、
前記コイルシースが挿通された絶縁性の被覆管と、
前記処置部を操作するための操作部と、
を備え、
前記操作部は、
前記操作ワイヤの基端が軸線回りに回転自在に接続された進退操作部と、
前記進退操作部が軸線方向に進退可能に取り付けられた本体と、
前記本体に対して軸線回りに回転可能に取り付けられ、前記コイルシースの基端が軸線回りに回転不能に取り付けられた回転操作部と、
を有し、
前記被覆管の先端は、前記コイルシースの先端に軸線回りに回転可能かつ軸線方向に進退不能に取り付けられており、
前記被覆管の基端側は、前記コイルシースに対して軸線方向に相対移動可能となるように離間しており、かつ前記コイルシースが湾曲しても前記コイルシースが露出しないように、所定の長さ以上前記操作部によって被覆されていることを特徴とする内視鏡用処置具。 A treatment section for performing treatment on tissue in the body cavity;
An operation wire connected to the proximal end of the treatment section;
A flexible coil sheath through which the operation wire is inserted;
An insulating cladding tube through which the coil sheath is inserted;
An operation unit for operating the treatment unit;
With
The operation unit is
An advancing / retreating operation unit in which a base end of the operation wire is rotatably connected around an axis;
A main body on which the advancing / retreating operation unit is attached so as to be movable back and forth in the axial direction;
A rotation operation unit attached to the main body so as to be rotatable about an axis, and a base end of the coil sheath being attached to be non-rotatable around the axis;
Have
The distal end of the cladding tube is attached to the distal end of the coil sheath so as to be rotatable about an axis and not to advance or retract in the axial direction.
The proximal end side of the cladding tube is spaced apart from the coil sheath so as to be relatively movable in the axial direction, and is longer than a predetermined length so that the coil sheath is not exposed even if the coil sheath is curved. A treatment instrument for an endoscope, which is covered with the operation section. 前記操作ワイヤの前記基端は、導電体からなるボールベアリングを用いて、前記進退操作部に対して軸線回りに回転自在に接続されており、
前記進退操作部は、電源と接続されるためのプラグを有し、
前記プラグは、前記ボールベアリングを介して前記操作ワイヤと導通していることを特徴とする請求項１に記載の内視鏡用処置具。 The base end of the operation wire is connected to the advance / retreat operation unit so as to be rotatable about an axis using a ball bearing made of a conductor,
The advance / retreat operation unit has a plug for connecting to a power source,
The endoscope treatment instrument according to claim 1, wherein the plug is electrically connected to the operation wire via the ball bearing.
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PCT/JP2009/003819 WO2010016280A1 (en) 2008-08-08 2009-08-07 Treatment instrument for endoscope
US13/022,748 US9161804B2 (en) 2008-08-08 2011-02-08 Treatment instrument for endoscope

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